Characteristics of behavioral symptoms in right-sided predominant semantic dementia and their impact on caregiver burden: a cross-sectional study

Shunsuke Sato, Mamoru Hashimoto, Kenji Yoshiyama, Hideki Kanemoto, Maki Hotta, Shingo Azuma, Takashi Suehiro, Kyosuke Kakeda, Yoshitaka Nakatani, Sumiyo Umeda, Ryuji Fukuhara, Minoru Takebayashi, Manabu Ikeda, Shunsuke Sato, Mamoru Hashimoto, Kenji Yoshiyama, Hideki Kanemoto, Maki Hotta, Shingo Azuma, Takashi Suehiro, Kyosuke Kakeda, Yoshitaka Nakatani, Sumiyo Umeda, Ryuji Fukuhara, Minoru Takebayashi, Manabu Ikeda

Abstract

Background: This study aimed to clarify the neuropsychiatric symptoms of right-sided predominant semantic dementia (SD-R) by comparing them with those of behavioral variant frontotemporal dementia (bvFTD), left-sided predominant SD (SD-L), and Alzheimer's disease (AD). This study also aimed to identify clinical factors related to caregiver burden for bvFTD, SD-R, and SD-L.

Methods: The neuropsychiatric symptoms of 28 patients with bvFTD, 14 patients with SD-R, 24 patients with SD-L, and 43 patients with AD were evaluated using the Neuropsychiatric Inventory (NPI) and the Stereotypy Rating Inventory (SRI). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Dementia severity was assessed using the Clinical Dementia Rating. Activities of daily living were assessed using the Lawton Instrument Activities of Daily Living (IADL) scale and the Physical Self-Maintenance Scale. We compared the NPI and SRI scores among the four groups using the Kruskal-Wallis test. In addition, clinical factors related to caregiver burden, represented by the Japanese version of the Zarit Burden Interview (J-ZBI), were analyzed using multiple regression analysis in the bvFTD, SD-R, and SD-L groups.

Results: The NPI total score and the NPI subscale scores of apathy and disinhibition were significantly higher in the bvFTD group than in the SD-L and AD groups. The SD-R group scores were closer to those of the bvFTD group than the SD-L group. The SRI total score and SRI subscale scores for eating and cooking and speaking were significantly higher in the bvFTD, SD-R, and SD-L groups than in the AD group. The NPI total score was significantly associated with the J-ZBI score in the bvFTD group. The NPI total score and Lawton IADL scale score were independently associated with the J-ZBI score in the SD-R group. Furthermore, the NPI total score and MMSE score were independently associated with the J-ZBI score in the SD-L group.

Conclusions: SD-R seemed to be a similar condition to bvFTD rather than SD-L regarding behavioral symptoms. Our results suggest that each frontotemporal dementia subgroup requires different approaches to reduce the caregiver burden.

Keywords: Alzheimer’s disease; Behavioral symptoms; Caregiver burden; Dementia; Frontotemporal dementia; Frontotemporal lobar degeneration; Primary progressive aphasia; Progressive non-fluent aphasia; Right temporal lobe atrophy; Semantic dementia.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Participant selection. MCI, mild cognitive impairment; AD, Alzheimer’s disease; DLB, dementia with Lewy bodies; VaD, vascular dementia; CBS, corticobasal syndrome; PSP, progressive supranuclear palsy; PDD, Parkinson disease with dementia; NPH, normal pressure hydrocephalus; nfvPPA, non-fluent/agrammatic variant primary progressive aphasia; lvPPA, logopenic variant primary progressive aphasia; DNOS, dementia not otherwise specified; bvFTD, behavioral variant frontotemporal dementia; SD-R, right-sided predominant semantic dementia; SD-L, left-sided predominant semantic dementia
Fig. 2
Fig. 2
NPI and SRI scores among the bvFTD, SD-R, SD-L, and AD groups. A NPI total score and SRI total score. B NPI subscale scores. C SRI subscale scores. Data were analyzed using the Kruskal-Wallis test. *p < 0.05/17 = 0.0029. NPI, Neuropsychiatric Inventory; SRI, Stereotypy Rating Inventory; bvFTD, behavioral variant frontotemporal dementia; SD-R, right-sided predominant semantic dementia; SD-L, left-sided predominant semantic dementia; AD, Alzheimer’s disease; AMB, aberrant motor behavior

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